NO PENSION, NO HAPPINESS?—FINANCIAL SUPPORT EXPECTATION IN THE OLDEST-OLD AGE AND DEPRESSIVE SYMPTOMS

Abstract Objective This paper aims to explore the effect of financial support expectation on depressive symptoms among the oldest-elderly. Method. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) 2018. The analytical sample included 10641 respondents who were older than 45. Financial support expectations refer to whom they would reply on when they cannot work, which includes four categories: children, themselves (savings or commercial life insurance), pensions, and others. Linear regression models were employed after controlling for pension, health insurance and urban-rural household registration (hukou). Results More than half of the sample reported that they would rely on their children when they became too old to work. Those who reported that they would rely on themselves (b=-1.72, p=0.000) or pensions (b=-1.23, p=0.000) reported lower levels of depressive symptoms compared to those who would rely on their children. When pension and health insurance were controlled for, only those who would rely on themselves presented lower level of depressive symptoms. Pension and health insurance (except rural health insurance) mediated the association between the financial support expectation and depressive symptoms. However, the hukou status inhibited the mediating effect of pension and health insurance. Conclusion Financial uncertainty is a potential threat in the oldest-old age. Reducing the urban-rural inequality in pension and health insurance would help reduce the negative effects of financial uncertainty.

With an aging US population, more people than ever live with serious illnesses.Although palliative care (PC) can improve outcomes in serious illness, there are inequities in PC utilization.People with low socioeconomic status (SES), men, and Black and Hispanic people are less likely to receive and benefit from PC services.Despite these established demographic differences in PC utilization, there is a dearth of relevant survey research on preferences for PC in the general population.To address this gap, we surveyed a random sample of 1,500 NJ adults.Respondents were given a brief definition of PC and asked to indicate how likely they would be to schedule, attend, and routinely attend PC visit(s) if they were diagnosed with a serious illness.Predictors included in logistic regression modeling were SES indicators (income, educational attainment, insurance status, employment status), gender, and race/ethnicity.Data were weighted to be representative of the population of NJ.Modeling results revealed that lower income and lower educational attainment were associated with significantly lower odds of endorsing willingness to schedule, attend, and routinely attend PC visits in the event that one would become seriously ill.Unexpectedly, there were no gender or race/ethnicity differences in preferences for PC.These findings highlight the importance of public health education for what PC is and its benefits for an aging population, especially among those with lower SES.Future research efforts are needed to understand discrepancies in reported PC preferences versus real-world PC utilization for men and Black and Hispanic individuals.

NO PENSION, NO HAPPINESS?-FINANCIAL SUPPORT EXPECTATION IN THE OLDEST-OLD AGE AND DEPRESSIVE SYMPTOMS Chengming Han, and Nan Zhou, Case Western Reserve University, Cleveland, Ohio, United States
Objective.This paper aims to explore the effect of financial support expectation on depressive symptoms among the oldest-elderly.Method.Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) 2018.The analytical sample included 10641 respondents who were older than 45.Financial support expectations refer to whom they would reply on when they cannot work, which includes four categories: children, themselves (savings or commercial life insurance), pensions, and others.Linear regression models were employed after controlling for pension, health insurance and urban-rural household registration (hukou).
Results.More than half of the sample reported that they would rely on their children when they became too old to work.Those who reported that they would rely on themselves (b=-1.72,p=0.000) or pensions (b=-1.23,p=0.000) reported lower levels of depressive symptoms compared to those who would rely on their children.When pension and health insurance were controlled for, only those who would rely on themselves presented lower level of depressive symptoms.Pension and health insurance (except rural health insurance) mediated the association between the financial support expectation and depressive symptoms.However, the hukou status inhibited the mediating effect of pension and health insurance.
Introduction Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk.Which frailty tool is ideal for risk stratification remains unclear.We calculated three frailty scores from the Million Veteran Program (MVP) and examined their association with mortality and CVD in older Veterans.Methods Participants were from MVP -a large, contemporary Veteran cohort study -and aged ≥50 years at baseline (2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018).The frailty scores used were: MVP-FI (36-item questionnaire deficit accumulation frailty index), VA-FI (31-item EHR index), and modified Study of Osteoporotic Fractures (mSOF; a physical frailty score).MVP-FI and VA-FI scores of ≤0.10 were robust, 0.11-0.20 pre-frail, and ≥0.21 frail; mSOF scores of 0 were robust, 1 pre-frail and ≥2 frail.Primary outcomes were all-cause and CVD mortality.Secondary outcomes were incident stroke, myocardial infarction (MI), and heart failure (HF).Cox regression was used to evaluate the association of frailty with outcomes.Results Among 190,688 participants, mean age was 69 ±9, 94% were male.By MVP-FI, 29% were robust, 42% pre-frail, and 29% frail.Hazard ratios (HR, 95% CI) for all-cause mortality were 1.66 (1.61-1.72)and 3.05 (2.95-3.16)for pre-frailty and frailty, respectively.For CVD mortality, HRs were 1.76 (1.65-1.88)and 3.65 (3.43-3.90)for pre-frailty and frailty.Hazards of stroke, MI, and HF also increased with greater frailty.VA-FI and mSOF yielded concordant results.Conclusion Irrespective of measure, frailty is associated with increased all-cause mortality and CVD event risk.Clinicians and researchers may consider the most convenient tool for available data to incorporate frailty into practice.

DEVELOP AND EXTERNALLY VALIDATE A RISK PREDICTION MODEL FOR SCREENING COGNITIVE FRAILTY IN OLDER ADULTS
Wenting Peng, Yuqian Luo, Cen Mo, Kehan Liu, and Minhui Liu, Central South University, Changsha, Hunan, China (People's Republic) Cognitive frailty, the combination of physical frailty and mild cognitive impairment, is a growing public health concern in aging populations.We aimed to develop and validate a risk prediction model for screening cognitive frailty in community-dwelling older adults without probable dementia (aged ≥ 65 years).We used Year 2011 data from National Health and Aging Trends Study (NHATS), with participants randomly divided into the training set (N=4,222) and internal validation set (N=2,111).We used Year 2015 data of NHATS as the external validation set (N=3,380).Cognitive frailty was assessed with the Fried phenotypic criteria and cognitive performance in three domains (memory, orientation and executive function).Independent risk factors were screened by multivariate logistic regression analysis.Model performance was assessed by discrimination (area under the curve [AUC]) and calibration (Hosmer-Lemeshow test).The final model included 13 key predictors (age, gender, education, smoke, walking for exercise, vigorous activity, self-rated health, depressive symptoms, balance impairments, arthritis, hospitalization, activities of daily living, and instrumental activities of daily living score).The model showed good discrimination with